| NPI | 1619077716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00093900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00093900) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-03-12 |